Results Summary

What was the research about?

The rate of major depressive disorder, or MDD, among teens has gone up over the last decade. Having MDD increases the risk for suicide, the second leading cause of death among teens. School-based screening can help identify teens with MDD and get them treatment.

In Pennsylvania, all schools have the Student Assistance Program, or SAP, that helps students with issues affecting success in school. Trained SAP staff can confirm if MDD symptoms require follow-up and refer students to school or community services if needed.

In this study, the research team compared two types of MDD screening for high school students:

  • Universal, or broad screening. All students completed a nine-question screener for MDD on an iPad. Students with MDD symptoms received a referral to their school’s SAP. Any student with suicidal thoughts received immediate services.
  • Targeted, or focused screening. Teachers, staff, and parents referred any students with concerning behavior to their school’s SAP. Schools in Pennsylvania currently use this approach for screening.

The research team wanted to learn which type of screening identified more students with MDD and helped get them treatment, especially those often missed in focused screening.

What were the results?

By the end of the school year, compared with students who received focused screening, students who received broad screening were:

  • Almost six times more likely to have their MDD symptoms identified through their school
  • More than three times more likely to have their need for follow-up services confirmed by the SAP
  • Two times more likely to start MDD treatment

Compared with focused screening, broad screening was better at identifying MDD among students who were female, Hispanic, or a race other than White or Black. These students are often missed in focused screening.

Rates of starting treatment didn’t differ by student sex, race, or ethnicity between the two types of screening.

Who was in the study?

The study included 12,909 students in 14 public high schools in Pennsylvania. Among students, 45 percent were White, 22 percent were Black, 21 percent were Hispanic, and 12 percent were another race or ethnicity. The median age was 16, and 54 percent were boys.

What did the research team do?

The research team assigned schools by chance to offer broad screening to students in either 9th and 11th grades, or 10th and 12th grades. Students in the other grades received focused screening.

School SAP teams tracked students who came to see them, who they referred for services, and who started treatment.

School staff, physical and mental health clinicians and advocates, parents, and teens provided input throughout the study.

What were the limits of the study?

Schools that chose to take part in the study had strong SAP teams. Results may differ for schools that don’t have SAP teams or whose teams are less prepared.

Future studies could look at broad screening for MDD in high schools in other states.

How can people use the results?

Schools can use these results when looking at how to identify students with MDD and get them treatment.

Final Research Report

This project's final research report is expected to be available by September 2023.

Engagement Resources

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Deepa L. Sekhar, MD, MSc
Penn State Health Milton S. Hershey Medical Center
Comparing Universal versus Targeted School Screenings for Depression among Teens -- The SHIELD Trial

Key Dates

August 2018
December 2022

Study Registration Information


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Last updated: February 2, 2023